0 - Clinical Presentations / Anatomical Landmarks Flashcards
Cubital Fossa
Borders:
- Plane b/t med. lat. epicondyles of humerus
- Brachioradialis
- Pronator Teres
Contents:
- Biceps Brachii Tendon (T)
- Brachial Artery (A)
- Median Nerve (N)
Place stethoscope here for blood pressure
Quadrangle Space
Borders:
- Teres Minor
- Long Head Triceps
- Teres Major
- Neck of Humerus
Contents:
- Axillary Nerve
- Post. Circumflex Humeral Artery
Triangular Interval
Borders:
- Teres Major
- Long and Lateral Head of Triceps
Contents:
- Radial Nerve
- Deep Brachial Artery
Anatomical Snuffbox
Borders:
- Abductor Pollicis Longus Tendon
- Extensor Pollicis Brevis Tendon
- Extensor Pollicis Longus Tendon
Contents:
- Radial Artery
- Trapezium
- Scaphoid (fracture felt here!)
Important for radial pulse and scaphoid fracture
Wrist Drop
Two Possible Causes
- Damage to Radial Nerve in radial groove; Fracture of Humerus at mid-shaft
- - - - Damage to Radial Nerve in Axilla; “Saturday Night Palsy” / Bad Crutches
- - -
Sensory Loss:
Posterior Arm, Forearm, Half-Hobo Glove Hand Distribution
Pain/Tenderness in Anatomical Snuff Box
FOOSH
Scaphoid Fracture
Ischemic Necrosis possible due ot distal distribution of blood supply in 10% of population
Trigger Finger
Thickening of Fibrous Digital Sheath
Stenosis of Osseofibrous tunnel
Flexor Digitorum Logus/Superficialis can catch on proximal edge of sheath
High Risk: Frequent Use / Rheumatoid Athritis
Mallet Finger
Tear of lateral slips of extensor expansions and unopposed action of long flexors
Hyperflexion of DIP joint
Tip of finger locked in flexion
Sliding into 2nd base w/your hands out in front
Boutonniere Deformity
Tear of central tendon of extensory expansions to middle phalanx at PIP Joint
Fancy ass looking fingers, flexed at middle joint
Injury to Superior Trunk (C5-C6)
Erb-Duchenne Palsy
Cause: Wide separation b/t head and shoulder
Sign: Waiter’s Tip Position
Nerve Loss:
Suprascapular N.
Musculocutaneous N.
Axillary N.
Motor Loss:
Supination (bicep)
Flexion (bicep)
Lat. Rotation (infraspinatus/teres minor)
Abduction (delt/supraspinatus)
Sensory Loss:
Lateral Cutaneous N. of Forearm
Upper Lateral Arm (Axillary Nerve)
Injury to Inferior Trunk (C8-T1)
Klumpke’s Palsy
Cause: Violent Abduction of Arm
Sign: Klumpke’s Claw (passive)
Nerve Loss:
Ulnar Nerve
Medial Part of Median Nerve
Medial Cutaneous Nerve of Arm/Forearm
Motor Loss:
Intrinsic muscles of hand (lumbricals/interossei)
Flex MP, Extend IP
Sensory Loss:
T1 Dermatome - Loss of cutaneous innervation of medial arm and medial forearm
Injury to Long Thoracic Nerve (C5-C7)
Injury to Long Thoracic Nerve (C5-C7)
Cause: Radical Masectomy/Knife fight
Sign: Winged Scapula
Nerve Loss: Long Thoracic Nerve
Motor Loss: Abduct arm above horizontal, winged scapula
Injury to Axillary Nerve
Injury to Quadrangular Space
Cause: Fracture of surgical neck of humerus, or dislocation of humerus
Sign: Motor/Sensory loss pattern
Nerve Loss: Axillary Nerve (C7)
Motor Loss: Loss of ability to rais arm past 15 deg (supraspinatus)
Sensory Loss: Upper Later Cutaneous N. of arm (police badge)
Damage to Radial Nerve (C7)
- Damage in AXILLA
Saturday Night Palsy
Cause: Prolonged pressure to armpit (crutches, chair)
Sign: Wrist Drop, cutaneous loss of arm, forearm, hand
Nerve Loss: Radial Nerve, Posterior cutaneous, half-hobo-glove
Motor Loss: Tricep Extension, Wrist Extension
Sensory Loss: Arm, Forearm, Half-Hobo-Glove
Damage to Radial Nerve (C7)
- Damage in HUMERUS
Cause: Fracture of Upper Arm
Sign: Wrist Drop, Hand numbness only
Nerve Loss: Radial nerve
Motor Loss: Wrist extension
Sensory Loss: Half-hobo-glove
Triceps NOT damaged, arm/forearm cutaneous NOT damaged
Damage to Median Nerve (C5-C6, C8-T1)
Cause: Supracondylar Fracture
Sign: Hand of Benediction
Nerve Loss: Median N., Recurrent Branch of Median Nerve
Motor Loss: Flexors/Pronators of Ant. Forearm, Thenar Muscles–no Opposition of Thumb, Hand of Benediction when patent tries to make fist
Sensory Loss: Reverse-Half-Hobo-Glove, 2/3 Palm
Brachial Artery also a concern
Damage to Median Nerve
Pain/Tingling in Distal Fingers, Hand
Carpal Tunnel Syndrome
Cause: Compression of median nerve
Sign: Pain/Tingling in finger tips, progressive
Nerve Loss: Median N.
Motor Loss: NA
Sensory Loss: Not full half-hobo glove, finger tips only on dorsal
Damage to Ulnar Nerve
- At Medial Epicondyle
Cause: Lesion at Medial Epicondyle
Sign: Weirdo Wave (no flexion of fingers), Ulnar Claw Hand, Can’t grip paper between fingers
Nerve Loss: Ulnar N., Palmar Branch of Ulnar, Dorsal Cutaneous Branch of Ulnar
Motor Loss: Flexion of MP Joints, Extension of PIP and DIP, Adduction-Abbduction of Fingers
Sensory Loss: Palm/Dorsum Fingers 4-5, Forearm
Ulnar Claw hand is PASSIVE
Damage to Ulnar Nerve
- At Wrist
Cause: Anything is possible
Sign: Loss of hypothenar, Interosseus and Adductor Pollicis
Nerve Loss: Distal branches of Ulnar, Palmar branch of ulnar
Motor Loss: Adduction/Abduction of hand, Impairment of flexion of MP joints, and extension of PIP and DIP
Sensory Loss: Dorsal Cutaneous NOT lost
What can the Shrug Test evaluate?
Accessory Nerve (Cranial Nerve XI)
Innervates the Trapezius
Most common broken bone in body?
Clavicle
Ligation of Subclavian Artery
Can be made anywhere between Thyrocervical Trunk and Subscapular Artery
Dislocation of AC-Joint
Separated Shoulder
Acromioclavicular and Coracoclavicular Ligaments torn
Dislocated side elevated due to trapezius - “Step Off Deformity”
Dislocation of Glenohumeral Joint
- Violent Abduction, Extension, and External Rotation
- Head of humerus driven posterior due to weakness of rotator cuff
- Axillary Nerve may be damaged
Final position is Inferior/Anterior
